Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Wednesday, March 10, 2010

Why not do things right in the first place?

I got an e-mail from the Centers for Medicare and Medicaid Services:

The Centers for Medicare & Medicaid Services (CMS) today terminated its contract with Fox Insurance Company. After an onsite review of the plan and its services, CMS determined that the plan’s significant deficiencies – not meeting Medicare’s requirements to provide enrollees with prescription drugs according to recognized standards of care – jeopardized the health and safety of Fox enrollees. CMS found that Fox committed a series of violations, including improperly denying its enrollees coverage of critical HIV, cancer, and seizure medications. The termination of the contract is effective immediately. . . .

Among the audit findings CMS found include:

· Failing to provide access to Medicare prescription drugs benefits by imposing unapproved prior authorization and step therapy criteria that made it more difficult for beneficiaries to get drugs that are protected by law.

· Not meeting the plan’s appeals deadlines,

· Not complying with Medicare regulations requiring enrollees to be transitioned to new drugs at the beginning of the new plan year.

· Failing to notify enrollees about prior authorization and step therapy determinations as required by Medicare.

But, the fact is, there is no reason for this company or others like it to exist in the first place. Congress could have just established a prescription drug benefit in Medicare, and let CMS negotiate with the drug companies for the best price and then pay for the damn drugs themselves, just like they pay for doctor and hospital services. But nooooooooo, they have to promise to enrich these predators in order to get a bill passed. Beneficiaries can't figure out who to sign up with or what plan to enroll in because you have to solve differential equations to get the right deal; and even if they could figure it out, they'd get ripped off anyway.

How's this for an idea: We need universal, comprehensive, single payer national health care. We don't need health insurance companies. At all.